|
Insertion of Intraocular Device 66030 - Admin Insertion of Intraocular Device
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
6045628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$533.64 |
| Max. Negotiated Rate |
$9,714.93 |
| Rate for Payer: Aetna Commercial |
$1,000.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Aetna Managed Medicare |
$2,428.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$722.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$555.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$533.64
|
| Rate for Payer: Anthem Medicare Advantage |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,428.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,428.73
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,022.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,428.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,428.73
|
| Rate for Payer: Health EOS Commercial |
$989.47
|
| Rate for Payer: HFN Commercial |
$1,022.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,034.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,428.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,428.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,428.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,428.73
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: NAPHCARE Commercial |
$3,643.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,022.82
|
| Rate for Payer: Quartz Beloit One Network |
$544.76
|
| Rate for Payer: Quartz Commercial |
$722.64
|
| Rate for Payer: Quartz Medicare Advantage |
$2,428.73
|
| Rate for Payer: The Alliance Commercial |
$9,714.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,428.73
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: Wellcare Medicare |
$2,428.73
|
| Rate for Payer: WPS Commercial |
$823.45
|
|
|
Insertion of Intraocular Device 66030 - Admin Insertion of Intraocular Device
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
6045628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$1,056.17 |
| Rate for Payer: Aetna Commercial |
$1,056.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Aetna Managed Medicare |
$96.99
|
| Rate for Payer: Anthem Medicare Advantage |
$96.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$96.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$96.99
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,056.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.99
|
| Rate for Payer: Health EOS Commercial |
$1,011.70
|
| Rate for Payer: HFN Commercial |
$1,056.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$387.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$96.99
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: NAPHCARE Commercial |
$145.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.17
|
| Rate for Payer: Quartz Beloit One Network |
$489.17
|
| Rate for Payer: Quartz Commercial |
$633.70
|
| Rate for Payer: Quartz Medicare Advantage |
$96.99
|
| Rate for Payer: The Alliance Commercial |
$412.21
|
| Rate for Payer: United Healthcare Medicaid |
$62.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.99
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$436.46
|
|
|
Insertion of Intraocular Device 66030 - Admin Insertion of Intraocular Device
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 66030
|
| Hospital Charge Code |
6045628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$544.76 |
| Max. Negotiated Rate |
$1,022.82 |
| Rate for Payer: Aetna Commercial |
$1,000.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$956.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$589.23
|
| Rate for Payer: Cash Price |
$320.70
|
| Rate for Payer: Cigna Commercial |
$1,022.82
|
| Rate for Payer: Health EOS Commercial |
$989.47
|
| Rate for Payer: HFN Commercial |
$1,022.82
|
| Rate for Payer: Multiplan Commercial |
$889.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,022.82
|
| Rate for Payer: Quartz Beloit One Network |
$544.76
|
| Rate for Payer: Quartz Commercial |
$667.06
|
| Rate for Payer: WEA Trust Commercial |
$611.47
|
| Rate for Payer: WPS Commercial |
$823.45
|
|
|
Insertion Of Intrauterine Device
|
Professional
|
Both
|
$733.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
1188878
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.85 |
| Max. Negotiated Rate |
$724.20 |
| Rate for Payer: Aetna Commercial |
$724.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.60
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$379.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.39
|
| Rate for Payer: Health EOS Commercial |
$693.71
|
| Rate for Payer: HFN Commercial |
$724.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.85
|
| Rate for Payer: Multiplan Commercial |
$609.86
|
| Rate for Payer: Preferred Network Access Commercial |
$724.20
|
| Rate for Payer: Quartz Beloit One Network |
$335.42
|
| Rate for Payer: Quartz Commercial |
$434.52
|
| Rate for Payer: The Alliance Commercial |
$381.16
|
| Rate for Payer: United Healthcare Medicaid |
$379.60
|
| Rate for Payer: WEA Trust Commercial |
$419.28
|
| Rate for Payer: WPS Commercial |
$564.63
|
|
|
Insertion of Intrauterine Device 58300 - Admin Insertion of Intrauterine Device Charge
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
3023772
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$277.51 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$892.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.36
|
| Rate for Payer: Aetna Managed Medicare |
$277.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$644.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$475.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.29
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$911.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$882.10
|
| Rate for Payer: HFN Commercial |
$911.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$743.34
|
| Rate for Payer: Multiplan Commercial |
$792.90
|
| Rate for Payer: NAPHCARE Commercial |
$594.67
|
| Rate for Payer: Preferred Network Access Commercial |
$911.83
|
| Rate for Payer: Quartz Beloit One Network |
$485.65
|
| Rate for Payer: Quartz Commercial |
$644.23
|
| Rate for Payer: Quartz Medicare Advantage |
$594.67
|
| Rate for Payer: The Alliance Commercial |
$495.56
|
| Rate for Payer: WEA Trust Commercial |
$545.12
|
| Rate for Payer: WPS Commercial |
$734.10
|
|
|
Insertion of Intrauterine Device 58300 - Admin Insertion of Intrauterine Device Charge
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
3023772
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$485.65 |
| Max. Negotiated Rate |
$911.83 |
| Rate for Payer: Aetna Commercial |
$892.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$525.29
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$911.83
|
| Rate for Payer: Health EOS Commercial |
$882.10
|
| Rate for Payer: HFN Commercial |
$911.83
|
| Rate for Payer: Multiplan Commercial |
$792.90
|
| Rate for Payer: Preferred Network Access Commercial |
$911.83
|
| Rate for Payer: Quartz Beloit One Network |
$485.65
|
| Rate for Payer: Quartz Commercial |
$594.67
|
| Rate for Payer: WEA Trust Commercial |
$545.12
|
| Rate for Payer: WPS Commercial |
$734.10
|
|
|
Insertion of Intrauterine Device 58300 - Admin Insertion of Intrauterine Device Charge
|
Professional
|
Both
|
$953.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
3023772
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.85 |
| Max. Negotiated Rate |
$941.56 |
| Rate for Payer: Aetna Commercial |
$941.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.36
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$941.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$379.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.67
|
| Rate for Payer: Health EOS Commercial |
$901.92
|
| Rate for Payer: HFN Commercial |
$941.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.85
|
| Rate for Payer: Multiplan Commercial |
$792.90
|
| Rate for Payer: Preferred Network Access Commercial |
$941.56
|
| Rate for Payer: Quartz Beloit One Network |
$436.09
|
| Rate for Payer: Quartz Commercial |
$564.94
|
| Rate for Payer: The Alliance Commercial |
$495.56
|
| Rate for Payer: United Healthcare Medicaid |
$379.60
|
| Rate for Payer: WEA Trust Commercial |
$545.12
|
| Rate for Payer: WPS Commercial |
$734.10
|
|
|
INSERTION OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 58300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,270.32 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
|
|
Insertion Of Non-Biodegradable Drug Delivery Implant 11981
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
CPT 11981
|
| Hospital Charge Code |
1188880
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$453.49 |
| Rate for Payer: Aetna Commercial |
$453.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$410.53
|
| Rate for Payer: Aetna Managed Medicare |
$51.45
|
| Rate for Payer: Anthem Medicare Advantage |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.45
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cigna Commercial |
$453.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$372.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.45
|
| Rate for Payer: Health EOS Commercial |
$434.40
|
| Rate for Payer: HFN Commercial |
$453.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$216.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$216.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.45
|
| Rate for Payer: Multiplan Commercial |
$381.89
|
| Rate for Payer: NAPHCARE Commercial |
$77.17
|
| Rate for Payer: Preferred Network Access Commercial |
$453.49
|
| Rate for Payer: Quartz Beloit One Network |
$210.04
|
| Rate for Payer: Quartz Commercial |
$272.10
|
| Rate for Payer: Quartz Medicare Advantage |
$51.45
|
| Rate for Payer: The Alliance Commercial |
$218.66
|
| Rate for Payer: United Healthcare Medicaid |
$372.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.45
|
| Rate for Payer: WEA Trust Commercial |
$262.55
|
| Rate for Payer: WPS Commercial |
$231.52
|
|
|
Insertion of Non-Indwelling Bladder Catheter
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
1188971
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$318.14 |
| Rate for Payer: Aetna Commercial |
$318.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$21.10
|
| Rate for Payer: Anthem Medicare Advantage |
$21.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.10
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$318.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.10
|
| Rate for Payer: Health EOS Commercial |
$304.74
|
| Rate for Payer: HFN Commercial |
$318.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.10
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$31.65
|
| Rate for Payer: Preferred Network Access Commercial |
$318.14
|
| Rate for Payer: Quartz Beloit One Network |
$147.35
|
| Rate for Payer: Quartz Commercial |
$190.88
|
| Rate for Payer: Quartz Medicare Advantage |
$21.10
|
| Rate for Payer: The Alliance Commercial |
$89.68
|
| Rate for Payer: United Healthcare Medicaid |
$59.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.10
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$94.96
|
|
|
INSERTION OF NON-INDWELLING BLADDER CATHETER (EG, STRAIGHT CATHETERIZATION FOR RESIDUAL URINE)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 51701
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
|
|
INSERTION OF PENILE PROSTHESIS
|
Facility
|
OP
|
$2,930.51
|
|
|
Service Code
|
EAPG 00182
|
| Min. Negotiated Rate |
$2,817.79 |
| Max. Negotiated Rate |
$2,930.51 |
| Rate for Payer: Anthem Medicaid |
$2,817.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,817.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,817.79
|
| Rate for Payer: Dean Health Medicaid |
$2,817.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,817.79
|
| Rate for Payer: Managed Health Services Medicaid |
$2,930.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,817.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,817.79
|
| Rate for Payer: United Healthcare Medicaid |
$2,817.79
|
|
|
Insertion of Peritoneal Catheter
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
5364747
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$15,071.89 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$3,767.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,052.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.38
|
| Rate for Payer: Anthem Medicare Advantage |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,767.97
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,767.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,767.97
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,016.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,767.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,767.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,767.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,767.97
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,651.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$3,767.97
|
| Rate for Payer: The Alliance Commercial |
$15,071.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,767.97
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: Wellcare Medicare |
$3,767.97
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
Insertion of Peritoneal Catheter
|
Professional
|
Both
|
$2,024.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
5364747
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.74 |
| Max. Negotiated Rate |
$1,999.71 |
| Rate for Payer: Aetna Commercial |
$1,999.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Aetna Managed Medicare |
$169.74
|
| Rate for Payer: Anthem Medicare Advantage |
$169.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$169.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$169.74
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,999.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$171.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.74
|
| Rate for Payer: Health EOS Commercial |
$1,915.51
|
| Rate for Payer: HFN Commercial |
$1,999.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$703.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$703.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$169.74
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: NAPHCARE Commercial |
$254.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,999.71
|
| Rate for Payer: Quartz Beloit One Network |
$926.18
|
| Rate for Payer: Quartz Commercial |
$1,199.83
|
| Rate for Payer: Quartz Medicare Advantage |
$169.74
|
| Rate for Payer: The Alliance Commercial |
$721.39
|
| Rate for Payer: United Healthcare Medicaid |
$171.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.74
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$763.82
|
|
|
Insertion of Peritoneal Catheter
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 49418
|
| Hospital Charge Code |
5364747
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,031.43 |
| Max. Negotiated Rate |
$1,936.56 |
| Rate for Payer: Aetna Commercial |
$1,894.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,810.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,115.63
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna Commercial |
$1,936.56
|
| Rate for Payer: Health EOS Commercial |
$1,873.41
|
| Rate for Payer: HFN Commercial |
$1,936.56
|
| Rate for Payer: Multiplan Commercial |
$1,683.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.43
|
| Rate for Payer: Quartz Commercial |
$1,262.98
|
| Rate for Payer: WEA Trust Commercial |
$1,157.73
|
| Rate for Payer: WPS Commercial |
$1,559.09
|
|
|
Insertion of Pleural Catheter
|
Professional
|
Both
|
$1,999.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
5364745
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$1,975.01 |
| Rate for Payer: Aetna Commercial |
$1,975.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,787.91
|
| Rate for Payer: Aetna Managed Medicare |
$174.76
|
| Rate for Payer: Anthem Medicare Advantage |
$174.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$174.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$174.76
|
| Rate for Payer: Cash Price |
$599.70
|
| Rate for Payer: Cash Price |
$599.70
|
| Rate for Payer: Cash Price |
$599.70
|
| Rate for Payer: Cigna Commercial |
$1,975.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$642.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.76
|
| Rate for Payer: Health EOS Commercial |
$1,891.85
|
| Rate for Payer: HFN Commercial |
$1,975.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$708.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$708.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$174.76
|
| Rate for Payer: Multiplan Commercial |
$1,663.17
|
| Rate for Payer: NAPHCARE Commercial |
$262.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,975.01
|
| Rate for Payer: Quartz Beloit One Network |
$914.74
|
| Rate for Payer: Quartz Commercial |
$1,185.01
|
| Rate for Payer: Quartz Medicare Advantage |
$174.76
|
| Rate for Payer: The Alliance Commercial |
$742.74
|
| Rate for Payer: United Healthcare Medicaid |
$642.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$174.76
|
| Rate for Payer: WEA Trust Commercial |
$1,143.43
|
| Rate for Payer: WPS Commercial |
$786.43
|
|
|
Insertion of Pleural Catheter
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
5364745
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$15,071.89 |
| Rate for Payer: Aetna Commercial |
$1,871.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,787.91
|
| Rate for Payer: Aetna Managed Medicare |
$3,767.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,351.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,039.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$997.90
|
| Rate for Payer: Anthem Medicare Advantage |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,101.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,767.97
|
| Rate for Payer: Cash Price |
$599.70
|
| Rate for Payer: Cash Price |
$599.70
|
| Rate for Payer: Cash Price |
$599.70
|
| Rate for Payer: Cigna Commercial |
$1,912.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,767.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,767.97
|
| Rate for Payer: Health EOS Commercial |
$1,850.27
|
| Rate for Payer: HFN Commercial |
$1,912.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,016.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,767.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,767.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,767.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,767.97
|
| Rate for Payer: Multiplan Commercial |
$1,663.17
|
| Rate for Payer: NAPHCARE Commercial |
$5,651.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,912.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,018.69
|
| Rate for Payer: Quartz Commercial |
$1,351.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3,767.97
|
| Rate for Payer: The Alliance Commercial |
$15,071.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,767.97
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,143.43
|
| Rate for Payer: Wellcare Medicare |
$3,767.97
|
| Rate for Payer: WPS Commercial |
$1,539.83
|
|
|
Insertion of Pleural Catheter
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
CPT 32550
|
| Hospital Charge Code |
5364745
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,018.69 |
| Max. Negotiated Rate |
$1,912.64 |
| Rate for Payer: Aetna Commercial |
$1,871.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,787.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,101.85
|
| Rate for Payer: Cash Price |
$599.70
|
| Rate for Payer: Cigna Commercial |
$1,912.64
|
| Rate for Payer: Health EOS Commercial |
$1,850.27
|
| Rate for Payer: HFN Commercial |
$1,912.64
|
| Rate for Payer: Multiplan Commercial |
$1,663.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,912.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,018.69
|
| Rate for Payer: Quartz Commercial |
$1,247.38
|
| Rate for Payer: WEA Trust Commercial |
$1,143.43
|
| Rate for Payer: WPS Commercial |
$1,539.83
|
|
|
Insertion of Temporary Indwelling Bladder Catheter
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
1188972
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.77 |
| Max. Negotiated Rate |
$293.44 |
| Rate for Payer: Aetna Commercial |
$293.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Aetna Managed Medicare |
$21.77
|
| Rate for Payer: Anthem Medicare Advantage |
$21.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.77
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$293.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.77
|
| Rate for Payer: Health EOS Commercial |
$281.08
|
| Rate for Payer: HFN Commercial |
$293.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.77
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: NAPHCARE Commercial |
$32.65
|
| Rate for Payer: Preferred Network Access Commercial |
$293.44
|
| Rate for Payer: Quartz Beloit One Network |
$135.91
|
| Rate for Payer: Quartz Commercial |
$176.06
|
| Rate for Payer: Quartz Medicare Advantage |
$21.77
|
| Rate for Payer: The Alliance Commercial |
$92.51
|
| Rate for Payer: United Healthcare Medicaid |
$76.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.77
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$97.95
|
|
|
INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; COMPLICATED (EG, ALTERED ANATOMY, FRACTURED CATHETER/BALLOON)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 51703
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$135.42 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$135.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.42
|
| Rate for Payer: NAPHCARE Commercial |
$203.13
|
| Rate for Payer: Quartz Medicare Advantage |
$135.42
|
| Rate for Payer: The Alliance Commercial |
$541.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.42
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$135.42
|
|
|
INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE (EG, FOLEY)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 51702
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
|
|
Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 36561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 36558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
|
|
INSERTION OF TUNNELED INTRAPERITONEAL CATHETER (EG, DIALYSIS, INTRAPERITONEAL CHEMOTHERAPY INSTILLATION, MANAGEMENT OF ASCITES), COMPLETE PROCEDURE, INCLUDING IMAGING GUIDANCE, CATHETER PLACEMENT, CONTRAST INJECTION WHEN PERFORMED, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, PERCUTANEOUS
|
Facility
|
OP
|
$15,071.89
|
|
|
Service Code
|
CPT 49418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,767.97 |
| Max. Negotiated Rate |
$15,071.89 |
| Rate for Payer: Aetna Managed Medicare |
$3,767.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,767.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,767.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,767.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,016.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,767.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,767.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,767.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,767.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,651.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,767.97
|
| Rate for Payer: The Alliance Commercial |
$15,071.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,767.97
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,767.97
|
|
|
INSERTION OF TUNNELED INTRAPERITONEAL CATHETER FOR DIALYSIS, OPEN
|
Facility
|
OP
|
$15,071.89
|
|
|
Service Code
|
CPT 49421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,767.97 |
| Max. Negotiated Rate |
$15,071.89 |
| Rate for Payer: Aetna Managed Medicare |
$3,767.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,767.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,767.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,767.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,016.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,767.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,767.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,767.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,767.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,651.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,767.97
|
| Rate for Payer: The Alliance Commercial |
$15,071.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,767.97
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,767.97
|
|
